Optical Devices in Tracheal Intubation—State of the Art in 2020

Abstract

The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.

Impact of choice of nostril on nasotracheal intubation when using video rigid stylet: a randomized clinical trial

“…The visible stylet for tracheal intubation has been employed since the 1980s. Since then, different types of visible stylets have been approved to facilitate tracheal intubation [ 14 ]. Slight differences exist between these stylets.…”

Comparison of the UEscope Video Laryngoscope with the Traditional Direct Laryngoscope in Neonates and Infants: A Randomized Clinical Trial

“…These devices include, but are not limited to, hybrid devices, optical stylets, single-use fiberscopes, and fiberoptic tracheal tubes. Although well-designed randomized clinical trials (RCTs) are limited, the efficacy of these new technologies have been reported in various studies including case series and cohort studies [ 6 ]. However, in the pediatric population, direct laryngoscopy is still the mainstream tool of tracheal intubation for surgical procedures, while video laryngoscopy (VL) is increasingly popular and used successfully in difficult airway situations [ 7 ].…”

Towards a universal, holistic, evidence-based consensus on difficult airway management: the new American Society of Anesthesiologists guidelines

“…During perioperative intubation, difficult airways show a relatively low incidence (4.4%) ( 3 ), slightly increased (4.7%) for critically ill patients ( 4 ). The development of new airway devices ( 5 ), the publication of national and international airway management guidelines and the possibility of improving technical and non-technical skills based on simulation scenarios contribute to the reduction of severe airway management complications. Nevertheless, closed claims analysis shows a decrease of adverse events occurring during general anesthesia induction, while no decreases are observed during the maintenance or extubation phase ( 6 ).…”